Most small medical practices expect MACRA to spell the end for their model, Blackbook says

Doctors responding to the survey are worried they will not have the technology, capital or staffing to survive.

In a May survey of 1,300 physician groups of five or less clinicians by Black Book Research, 67 percent of high Medicare-volume doctors said they foresee the end of their independence due to The Medicare Access and CHIP Reauthorization Act of 2015.

MACRA, replaced the controversial Medicare Part B Sustainable Growth Ratereimbursement formula with a new value-based reimbursement system. Some doctors responding to the survey are worried they will not have the technology, capital or staffing to survive under the conditions of the Merit-based Incentive Payment System.

Despite small practice education, training and technical assistance programs promised from the Centers for Medicare and Medicaid Services to help physicians with the MACRA programs, 89 percent of the remaining solo practices expect to minimize Medicare volumes so they're not required to submit reports for the quality and clinical practice improvement activities, or report in the cost performance category.

Seventy-seven percent of small practices identified themselves as financially struggling due to physician staffing losses directly to larger group practices and hospital integrated delivery networks, the survey found. Seventy-two percent also blame their underperforming billing technology and compounding payment issues for their troubles.

"Physician payment based on 2017 performance isn't scheduled to kick in until 2019," said Doug Brown, managing partner of Black Book, in a statement. "That's far too long to maintain operations for the most stressed practices to hold on with outmoded technology and scarce billing support."

Brown said the apparent solution for 78 percent of remaining independent primary care physicians is to join a bigger group or IDN to gain needed reporting, revenue cycle tools and support before 2019.

Black Book expects the electronic health record replacement market to decline in the small practice market, as 55 percent of independent practitioners said they will make no technology shifts or purchases until they have made decisions on being acquired.

"On the other hand, the growth opportunities for EHR vendors currently serving the larger practice market, IDNs and multi-specialty clinics are expected to appreciably benefit from these small practice acquisitions," said Brown.

Based on the aggregate client experience and customer satisfaction scores on 18 performance indicators -- tuned to physician practice integration of documentation, operations and revenue cycle management -- the top-ranked electronic health records for small practices have changed. More cloud-based EHRs have made competitive pricing one of several demands, particularly integrated billing, specialist-driven focuses, mobility, interoperability and patient satisfaction support.

Sixty-three percent of practices with fewer than 10 practitioners, as well as solo practice physicians, have still not settled on a technology suite or set of products that delivers to their expectations on meaningful use, clinician usability, interoperability and coordinated billing and claims, according to the survey. But over a third of those slower adopters expect to make product decisions before the end of this calendar year.

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